What Part of Medicare Covers Cataract Surgery?
Understand the intricacies of Medicare coverage for cataract surgery, including costs, limitations, and how different plans apply.
Cataract surgery restores vision by replacing a clouded natural lens with an artificial one. This common surgery becomes necessary when cataracts significantly impair daily activities. Medicare generally covers medically necessary cataract surgery.
Original Medicare Coverage for Cataract Surgery
Original Medicare, composed of Part A (Hospital Insurance) and Part B (Medical Insurance), provides coverage for cataract surgery when a healthcare provider deems it medically necessary. Most cataract surgeries are performed in an outpatient setting, making Medicare Part B the primary component for coverage. Part B covers a range of services related to the outpatient procedure, including pre-operative examinations, the surgical removal of the cataract, the implantation of a standard intraocular lens (IOL), and post-operative care. This also extends to facility fees for the surgical center and professional fees for the surgeon and anesthesiologist. Medicare Part B will also cover one pair of prescription eyeglasses with standard lenses or contact lenses after the surgery.
While cataract surgery is typically an outpatient procedure, Medicare Part A covers inpatient hospital stays if medically required due to complications. Part A covers hospital-related expenses, including the hospital room, nursing care, and other inpatient services.
Medicare Advantage Plans and Cataract Surgery
Medicare Advantage plans, also known as Medicare Part C, offer an alternative way to receive Medicare benefits, including coverage for cataract surgery. These plans are provided by private insurance companies approved by Medicare and are required to cover at least everything that Original Medicare (Parts A and B) covers. Medically necessary cataract surgery is included in Medicare Advantage plans.
While the scope of covered medical services for cataract surgery is comparable to Original Medicare, the specific costs and administrative rules can differ significantly. Medicare Advantage plans may have varying deductibles, copayments, and coinsurance amounts for the surgery, facility fees, and doctor visits. These plans often operate with network restrictions and may require prior authorization for procedures. Some Medicare Advantage plans may offer additional vision benefits beyond the core surgical procedure, such as allowances for eyewear, but these are distinct from the coverage for the surgery itself.
Prescription Drug Coverage
Following cataract surgery, individuals often require prescription medications, such as eye drops, to aid in recovery and prevent complications like infection or inflammation. Medicare Part D, which provides prescription drug coverage, addresses these needs. Part D plans cover prescribed eye drops or other oral medications necessary for post-surgical care.
The specific costs for these medications, including deductibles and copayments, will vary depending on the individual’s chosen Part D plan. Part D specifically covers the cost of these pharmaceutical needs, separate from the surgical procedure itself, which falls under Part B or a Medicare Advantage plan. Patients should verify their plan’s formulary to understand coverage for specific medications prescribed after the surgery.
Costs and Coverage Limitations
Individuals will incur out-of-pocket costs for cataract surgery. For those with Original Medicare, after meeting the annual Part B deductible, which is $257 in 2025, patients are typically responsible for 20% of the Medicare-approved amount for Part B services. Medigap policies, also known as Medicare Supplement plans, can help cover these out-of-pocket expenses, including the Part B deductible and coinsurance.
Medicare Advantage plans also involve out-of-pocket costs, such as copayments or coinsurance for the surgery, facility, and doctor visits, which vary based on the specific plan. These plans have annual out-of-pocket maximums, which can provide a financial ceiling for a patient’s expenses.
Medicare covers standard monofocal intraocular lenses (IOLs) but generally does not cover premium or advanced IOLs that correct astigmatism or provide multifocal vision. If a patient chooses these advanced lenses, they will be responsible for the additional cost beyond what Medicare covers for a standard IOL. Similarly, elective procedures or technologies, such as certain laser-assisted techniques, may not be fully covered if they are considered enhancements over traditional surgery and not medically necessary. Routine eyeglasses or contact lenses are generally not covered, though Medicare Part B does cover one pair of corrective lenses after the initial cataract surgery.